Condition Factsheets

Infertility

The Facts on Infertility

Infertility is usually defined as the inability to become pregnant after one year of vaginal intercourse without birth control.

Infertility affects about 10% of couples in their reproductive age. Approximately one-third of infertility cases can be attributed to a fertility issue with the woman; one-third with the man; and one-third with either both partners or the cause of the infertility is never found.

People shouldn't assume that they or their partners are infertile until they've tried and failed to conceive for at least 6 months if the female partner is 35 years or older, or for at least one year if the female partner is less than 35 years of age. If you are still unable to get pregnant after this time, check with your doctor. Fortunately, it's not uncommon for couples to suddenly conceive a child after years of trying unsuccessfully without treatment.

Get ready to talk to your doctor about trying to get pregnant.

Fill out this short doctor discussion guide to help you start the discussion and determine the best approach and next steps for you.

Fertility Doctor Discussion Guide

Have you been actively trying to get pregnant for twelve
months or more? (or six months or more if you're 35 or older)Have you or your partner already been diagnosed with
a fertility problem?Have you tried using ovulation predictor kits / BBT
charts / other?Would you like to find out more about your treatment options?Do you feel concerned that you have been unsuccessful
to date?As a result of your inability to get pregnant, do you find yourself uncomfortable around family or friends with children?Has your inability to get pregnant had a negative effect
on your relationship with your partner?Has your inability to get pregnant negatively affected
your sexual relationship with your partner?Do your fertility problems get in the way of your work
or home life obligations?

Now you're ready to talk to your doctor about trying to get pregnant. Just print this sheet and bring it with you to your next doctor's appointment. Also write down any specific questions you have.

Keep in mind that many options are available to help you get pregnant and that you're not alone in your journey. To find out more about fertility,
visit the Fertility channel.

Causes of Infertility

Infertility in both women and men can be caused by a variety of medical conditions and problems.

Causes of infertility in women include:

age

chlamydia and other sexually transmitted infections (STIs)

damaged ovaries

blocked fallopian tubes

hypothyroidism (a thyroid disorder)

endometriosis (a condition where cells from the womb lining are found outside the womb)

polycystic ovary syndrome

scarring in the uterus

fibroids (benign smooth-muscle tumours of the uterus)

congenital diseases like cystic fibrosis

excessive exercise (leading to missed menstrual periods)

anorexia or bulimia

frequent changes in weight

damage to the cervix (e.g., through an abortion or dilatation and curettage [D&C])

Infertility may seem more common these days because more people are choosing to have children later in life. But because women are less fertile as they age, women in their late 30s and early 40s naturally have a harder time conceiving, even with treatment. Although 25% to 50% of women dealing with infertility are found to have at least some traces of endometriosis upon examination, it is not known in some cases if this is the cause of the infertility.

Some women suffer repeated miscarriages, which are often due to immune problems, genetic problems, hormonal problems or occasionally, a uterus that is slightly misshapen. In a few cases, perfectly healthy couples can't conceive because mucous produced in the lining of the woman's cervix may interfere with the sperm moving into the uterus. The couple may be considered reproductively "incompatible," but this is a treatable situation. Occasionally, the man's sperm is unable to penetrate the woman's egg, but there is a treatment for this, too, and it requires in-vitro fertilization (IVF).

Hyperprolactinemia is another possible cause of infertility in women. This is an excess of the hormone prolactin, which normally stimulates breast milk production in women. High prolactin levels can interfere with ovulation and menstruation. Stress, marijuana, and hypothyroidism are among the factors believed to contribute to high prolactin levels. Certain prescription medications can also cause an elevated prolactin level. Rarely, it may be caused by a very small tumour in the pituitary gland of the brain that is easily treated with medication.

Women may also be concerned that having used birth control pills, vaginal rings, patches, and injections could possibly make them less fertile after they have stopped using them. There is no evidence that using birth control pills, vaginal rings, or patches increases the risk of infertility; however, you may want to delay trying to get pregnant for at least one menstrual cycle after stopping these medications. This is to help you get the cycle restarted even though your periods were regular when you were using these birth control methods. However, if you had irregular or infrequent periods before you began taking birth control pills or any one of these hormonal methods of birth control, your periods are likely to go back to the way they were. That is, if you were having periods every 1 to 2 months or so, the pattern will restart itself and return.

Using intrauterine devices (IUD) has also not been shown to increase the risk of infertility in women. Some women who use injection birth control methods (progesterone injections) may notice that it may take almost a year for their periods to restart and for fertility to return. Talk to your doctor or pharmacist about whether infertility may result from your method of birth control and if so, how long this time may be.

Causes of infertility in men include:

hormone disturbance

smoking

overheating of the testicles caused by exercise, hot water, tight clothing, excessive sitting (truck drivers) and other conditions and situations

cancer medications and radiation therapy

mumps after puberty

STIs

anatomical abnormalities of the genitals such as undescended testicles

use of some medications, such as some for high blood pressure, some antidepressants, and male hormones

genital injury

prostate surgery

varicose veins in the testicles

excessive alcohol

intercourse problems such as premature withdrawal or poor timing with their partner's menstrual cycle

spinal cord injury

genetic abnormalities

urinary tract infection

cystic fibrosis

illicit drug use (e.g., using cocaine, smoking marijuana)

opiates

steroids

Some men are more prone than others to infertility problems. These factors contribute to the risk of infertility:

diabetes

poor nutrition

smoking (lowers sperm count and reduces erections)

hot baths

being very overweight or underweight

The environment may also affect fertility. Sperm counts are going down in industrialized countries due to unknown environmental factors.

Types of male infertility include:

azoospermia: no sperm in the ejaculate

oligospermia low concentrations of sperm in the ejaculate

asthenospermia sperm are present but can't swim normally

teratospermia high proportion of abnormally-shaped sperm

retrograde ejaculation the tube through which sperm normally travel is blocked and sperm may end up in the bladder

Symptoms and Complications of Infertility

A young, reproductively healthy couple who isn't using contraception has roughly a 20% chance of conceiving in any given month. If someone is young and has no reason to think they might be infertile, they should try for up to a year before considering consulting a physician regarding some kind of infertility treatment. If the female partner is over 35, most fertility specialists recommend seeking treatment after 6 months, so that the chances can be improved while the woman is still young enough to be fairly confident of a problem-free pregnancy.

The contents of this site are for informational purposes only and are meant to be discussed with your physician or other qualified health care professional before being acted on. Never disregard any advice given to you by your doctor or other qualified health care professional. Always seek the advice of a physician or other licensed health care professional regarding any questions you have about your medical condition(s) and treatment(s). This site is not a substitute for medical advice.